Trauma Nurse Fellowship: Developing the Novice Trauma Nurse
Laura Garlow, MHA, BSN, RN, TCRN; Lisa Ulbricht, BSN, RN, CEN, TCRN; Anita Johnson, BSN, RN; Jamie Van Ness, BSN, RN, CEN; Jayne Petefish, MS, ANCS-BC, CCRN; Stacy Petrucelli, BSN, RN; Amanda Coetzee, BSN, RN, CEN, TCRN; Tress Ritter, BSN, RN, CEN; Barry Renz, MD, FACS; Lonnie Moton, MSN, CNP, CNL; Nancy Ballard, PhD, RN, NEA-BC
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Session B presented Thursday, September 14, 2017
Purpose: Residency and fellowship programs have successfully been implemented in combination with workshops to develop nurses and increase nursing knowledge over the past several years. These programs can improve both quality and efficiency of care; improve work satisfaction, engagement, confidence, team relationship and to reduce turnover. There are gaps in the literature related to the effectiveness of short term fellowship and residency programs. The Trauma Nurse Fellowship (TNF) is a condensed education program that incorporates lecture, simulation, and clinical experience to maximize learning.
Design: This is a feasibility study to determine the effectiveness of the TNF on new trauma nurse development.
Setting: The setting is a suburban Level II trauma center in the southeastern US. The nursing units include: ED, TICU and floor.
Participants/Subjects: A convenience sample of 12 novice trauma RNs was selected by their respective managers. Participants must have demonstrated readiness by exhibiting quality nursing skills.
Methods: Over seven weeks, each participant completed didactic and clinical hours. Training included all aspects of the trauma continuum through lectures, clinical rotations and simulation. Clinical rotations included but were not limited to: ED, TICU, floor, EMS, and shadowing the trauma surgeons. Case studies were presented. Knowledge gained was measured by a pre- and post-test using a current TNCC 50-question exam, used with permission from the ENA. At the conclusion of the TNF, participants completed TNCC using a different version of the exam. The TNF and non-TNF scores were compared. Standard demographic data was collected via electronic survey along with before and after measures of participants' perceptions of confidence as trauma nurses.
Results/Outcomes: There was a 9.4% significant (significance level of p = 0.05) increase from pre/post test scores (60.3%vs 69.7%, p = 0.001). Upon completion of TNCC, there was a statistically significant difference in mean scores between TNF participants (TNF-P) and non-TNF-P written scores (91.5% vs 85.6%, p=0.024). When compared to three previous local courses, TNF-P out performed non-TNF-Ps (91.5% vs 88.1%, p = 0.055). The difference in skills test scores was not significant. Participants demonstrated improved perceptions of confidence across all five domains: individual and team role knowledge, knowledge in trauma care, teamwork, and communication.
Implications: There was improvement in knowledge as a result of participation in the TNF. It was further validated by the TNF-P performance compared to non-TNF-P in written and TNP testing during TNCC. Their scores were compared to cohorts from the three most recent local courses as well as their own course cohort. The TNF increases the nurses’ confidence in the areas of communication, teamwork, skill, and knowledge of trauma care and roles and responsibilities. A lengthy TNF is difficult to justify in today’s climate of nursing shortage and hospital fiscal responsibility. To increase nurses’ knowledge and competence, the TNF focuses on critical components of trauma care in a condensed fellowship. Limitations of this study included a small sample size and variability in clinical exposure to trauma activations. Planning a second cohort is underway. Data will be collected to validate the findings of this study.
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